DOCSLIB.ORG

Active Approaches to Latent Tuberculosis: Modelling Public Health Strategies Towards Eliminating Tuberculosis in Australia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Active Approaches to Latent Tuberculosis: Modelling Public Health Strategies Towards Eliminating Tuberculosis in Australia Active approaches to latent tuberculosis: modelling public health strategies towards eliminating tuberculosis in Australia Justin Timothy Denholm Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy March 2013 Department of Medicine (RMH/WH) The University of Melbourne 1 2 Declaration This is to certify that: (i) the thesis comprises only my original work towards the PhD except where indicated, (ii) due acknowledgement has been made in the text to all other material used, (iii) the thesis is fewer than 100,000 words in length, exclusive of tables, maps, bibliographies and appendices. ……………………………………………. Justin Timothy Denholm 3 4 Acknowledgements I would like to thank the National Health and Medical Research Council for supporting this work through a postgraduate scholarship. I would also like to thank Dennis and Eileen Bakke and the Mustard Seed Foundation for generous financial support and invaluable personal encouragement through the Harvey Fellowship program during my doctoral candidacy. A number of individuals and organisations have provided assistance and support without which this work would not have been possible. I would especially like to acknowledge the Peter Doherty Institute, Nossal Institute for Global Health, Victorian Infectious Diseases Service, Department of Health Victoria and the Victorian Infectious Diseases Reference Laboratory. Most substantial thanks must be given to my doctoral supervisors, Associate Professor Emma McBryde and Professor Graham Brown. Their expertise, insight and enthusiasm have both encouraged and restrained me periodically throughout this process, and I am very thankful for them. Finally, I would like to thank my family, who have, I think, enjoyed this period of doctoral study despite having to sustain me through it periodically! My parents, Carey and Laura, have provided me with tools and models over a lifetime. My wife Gina and my children William, Charlie and Susannah are a delight and blessing in every way – thank you all. Soli deo gloria 5 Table of contents Declaration ......................................................................................................................... 3 Acknowledgements ............................................................................................................ 5 Table of contents ................................................................................................................ 6 Publications arising from this thesis ................................................................................ 11 List of Tables ................................................................................................................... 12 List of Figures .................................................................................................................. 13 Abstract ............................................................................................................................ 15 1.1 What is latent tuberculosis? .............................................................................. 17 1.1.1 Biology ………………………………………………………… 17 1.1.2 Public health ......................................................................................... 18 1.2 How is LTBI managed? ................................................................................... 20 1.2.1 Diagnosis .............................................................................................. 20 1.2.2 Individual treatment strategies ............................................................. 21 1.2.3 Regimens for treatment of LTBI .......................................................... 24 1.3 Population-based strategies relating to LTBI ................................................... 36 1.3.1 Theoretic value and examples of use ................................................... 36 1.3.2 Limitations in development and assessment of public health strategies38 1.4 Estimating population prevalence of LTBI ...................................................... 38 1.4.1 Population surveys ............................................................................... 39 1.4.2 Improving estimates of LTBI with alternative study methods ............. 43 1.4.3 Mathematical approaches to improving experimentally-derived LTBI prevalence ............................................................................................. 44 1.4.4 Theoretical mathematical approaches .................................................. 46 1.4.5 Need for improved methods ................................................................. 48 1.5 Estimating reactivation rates ............................................................................ 48 1.5.1 Basis for current estimates ................................................................... 48 1.5.2 Limitations in current understanding and possibilities for improvement51 6 1.6 Summary of the limits of current understanding of LTBI and implications for evaluation of public health strategies ......................................................... 52 2. Estimating latent TB prevalence and TB risk in immigrant cohorts ......................... 54 2.1 Estimating tuberculin test reactivity in Chinese immigrants ........................... 55 2.1.1 Background .......................................................................................... 55 2.1.2 Aim ……………………………………………………………………58 2.1.3 Methods ………………………………………………………………..58 2.1.4 Results ………………………………………………………………..58 2.1.5 Discussion ............................................................................................ 61 2.2 Adjusting LTBI prevalence estimates using a latent-class, random effects approach ........................................................................................................... 62 2.2.1 Aims ……………………………………………………………….63 2.2.2 Methods ……………………………………………………………….63 2.2.3 Results ……………………………………………………………….63 2.2.4 Discussion ............................................................................................ 65 2.3 Estimating risk of tuberculosis reactivation in Australian immigration cohorts. ............................................................................................................. 66 2.3.1 Aims ……………………………………………………………….66 2.3.2 Methods ……………………………………………………………….66 2.3.3 Results ………………………………………………………….……68 2.3.4 Discussion ............................................................................................ 74 2.4 Summary of approach to estimating TB risk for public health evaluation ...... 76 3. Current approaches to management of LTBI in Australasia ..................................... 78 3.1 Existing guidelines for the management of LTBI ............................................ 78 3.1.1 Aim ……………………………………………………………….79 3.1.2 Methods …………………………………………………………….…79 3.1.3 Results …………………………………………………………….…80 3.1.4 Discussion ............................................................................................ 81 3.2 LTBI management survey ................................................................................ 83 3.3 Treatment of suspected multidrug resistant LTBI ............................................ 93 7 3.4 Potential impact of optimizing current management practices on public health ................................................................................................................ 93 3.4.1 Limiting drug resistance in TB ............................................................. 94 3.4.2 Improved cost-effectiveness ................................................................. 94 3.5 Conclusions ...................................................................................................... 95 4. Multidrug resistant LTBI in Victoria, Australia ........................................................ 97 4.1 Aims ................................................................................................................. 98 4.2 Methods ............................................................................................................ 98 4.3 Results ............................................................................................................ 102 4.4 Discussion ...................................................................................................... 108 4.5 Summary and implications for public health evaluation ................................ 110 5. Risk factors for tuberculosis reactivation ................................................................ 112 5.1 HIV ................................................................................................................. 113 5.2 Diabetes mellitus ............................................................................................ 114 5.3 Tobacco smoke ............................................................................................... 115 5.4 Vitamin D deficiency ..................................................................................... 116 5.5 Genetic factors ................................................................................................ 117 5.5.1 Human leukocyte antigens (HLA) ..................................................... 119 5.5.2 Vitamin D receptor (VDR) ................................................................. 119 5.5.3 SLC11A1 ............................................................................................ 120 5.6 Novel meta-analysis of mannose-binding lectin gene (MBL2) polymorphisms and TB susceptibility
Load more

Recommended publications
  • Tuberculosis Prevention, Diagnosis, and Care in Manitoba, 2008-2010
    Tuberculosis Prevention, Diagnosis, and Care in Manitoba, 2008-2010: A Performance Analysis by C. Andrew Basham A Thesis submitted to the Faculty of Graduate Studies of The University of Manitoba in partial fulfilment of the requirements for the degree of MASTER OF SCIENCE Department of Community Health Sciences University of Manitoba Winnipeg Copyright © 2016 by C. Andrew Basham ABSTRACT A cross-sectional study of Manitoba TB Registry data was conducted using a set of performance measures based on the US Centers for Disease Control and Prevention TB Performance Objectives and Targets framework. The study investigated all cases of TB diagnosed in Manitoba during the period of 2008 to 2010 (inclusive), and their contacts. Seven performance measures (PMs) were analyzed: treatment completion/cure, early diagnosis, HIV testing/reporting, paediatric cases, retreatment cases, contact elicitation, and contact assessment. Ethnic-origin, age, sex, geographic, and treatment history groups were compared on these PMs through log-binomial and robust Poisson regression analyses, implemented through a generalized estimating equations (GEE) modelling approach. An updated epidemiological profile is provided, along with a baseline of performance in TB prevention, diagnosis, and care in Manitoba. Significant differences were found between Manitoba sub-populations in the PMs. The PM framework developed in this study provided valuable information for TB program planning and evaluation. i ACKNOWLEDGEMENTS I would like to thank my Thesis Committee, and in particular Drs. Elias and Orr, for their commitment of time and energy towards this study. I would also like to acknowledge the Western Regional Training Centre in Health Services and Policy Research (WRTC) for providing me the funding to enter the M.Sc.
    [Show full text]
  • Toman's Tuberculosis Case Detection, Treatment, and Monitoring
    TOMAN’S TUBERCULOSIS TOMAN’S TUBERCULOSIS CASE DETECTION, TREATMENT, AND MONITORING The second edition of this practical, authoritative reference book provides a rational basis for the diagnosis and management of tuberculosis. Written by a number of experts in the field, it remains faithful to Kurt Toman’s original question-and-answer format, with subject matter grouped under the three headings Case detection, Treatment, and Monitoring. It is a testament to the enduring nature of the first edition that so much CASE DETECTION, TREA material has been retained unchanged. At the same time, the new edition has had not only to address the huge resurgence of tuber- culosis, the emergence of multidrug-resistant bacilli, and the special needs of HIV-infected individuals with tuberculosis, but also to encompass significant scientific advances. These changes in the profile of the disease and in approaches to management have inevitably prompted many new questions and answers and given a different complexion to others. Toman’s Tuberculosis remains essential reading for all who need to AND MONITORING TMENT, QUESTIONS learn more about every aspect of tuberculosis – case-finding, manage- ment, and effective control strategies. It provides invaluable support AND to anyone in the front line of the battle against this disease, from ANSWERS programme managers to policy-makers and from medical personnel to volunteer health workers. SECOND EDITION ISBN 92 4 154603 4 WORLD HEALTH ORGANIZATION WHO GENEVA Toman’s Tuberculosis Case detection, treatment, and monitoring – questions and answers SECOND EDITION Edited by T. Frieden WORLD HEALTH ORGANIZATION GENEVA 2004 WHO Library Cataloguing-in-Publication Data Toman’s tuberculosis case detection, treatment, and monitoring : questions and answers / edited by T.
    [Show full text]
  • World Bank Document
    Document of The World Bank Public Disclosure Authorized Report No. 15894-IN STAFF APPRAISAL REPORT INDIA Public Disclosure Authorized PROPOSED TUBERCULOSIS CONTROL PROJECT January 6, 1997 Public Disclosure Authorized Public Disclosure Authorized South Asia Country Department II (Bhutan, India and Nepal) Population and Huaman Resources Operations Division CURRENCY EQUIVALENTS (As of July 1996) Currency Unit = Rupee Rupee 34.70 =US$ 1.00 Rupee 1.0 US$ 0.0288 METRIC EQUIVALENTS 1 Meter (m) 3.28 Feet (ft) 1 Kilometer 0.62 Miles GOVERNMENT FISCAL YEAR April 1 - March 31 ABBREVIATIONS AND ACRONYMS ADGHS Assistant Director General of Health Services AFB Acid Fast Bacilli AIDS Acquired Immunodeficiency Syndrome ARI Annual Risk of Infection BCG Bacilli of Calmette and Guerin BRS Basic Radiological System CDC Centers for Disease Control and Prevention CHC Community Health Center CHEB Central Health Education Bureau DALYs Disability Adjusted Life Years DANIDA Danish Development Agency DDG Deputy Director General DGHS Director General of Health Services DHO District Health (Medical) Officer DOT Directly-Observed Therapy DTC District Tuberculosis Center DTO District Tuberculosis Officer E Ethambutol GOI Government of India H or INH Isoniazid - ii - ABBREVIATIONS AND ACRONYMS (Continued) HIV Human Immunodeficiency Virus IDA International Development Agency IMA Indian Medical Association LCC Long Course Chemotherapy LSHTM London School of Hygiene and Tropical Medicine MIS Management Information System MO Medical Officer MOHFW Ministry of Health and
    [Show full text]
  • The Roles of Stochasticity and Life History in the Evolutionary
    Research Collection Doctoral Thesis Within-host population dynamics and the evolution of drug resistance in bacterial infections Author(s): Cadosch, Dominique Richard Publication Date: 2016 Permanent Link: https://doi.org/10.3929/ethz-a-010795126 Rights / License: In Copyright - Non-Commercial Use Permitted This page was generated automatically upon download from the ETH Zurich Research Collection. For more information please consult the Terms of use. ETH Library DISS. ETH NO. 23499 WITHIN-HOSTPOPULATIONDYNAMICSANDTHEEVOLUTION OFDRUGRESISTANCEINBACTERIALINFECTIONS A thesis submitted to attain the degree of DOCTOR OF SCIENCES of ETH ZÜRICH (Dr. sc. ETH Zürich) presented by DOMINIQUERICHARDCADOSCH M.Sc. ETH Zürich, Switzerland born on 30.05.1984 citizen of Vaz/Obervaz GR, Switzerland accepted on the recommendation by Prof. Dr. Sebastian Bonhoeffer, examiner Prof. Dr. Theodore H. Cohen, co-examiner PD Dr. Roland Regoes, co-examiner 2016 To my parents, Ruth and Edgar Cadosch, for their sedulous support and guidance. “I have a friend who’s an artist and has sometimes taken a view which I don’t agree with very well. He’ll hold up a flower and say "look how beautiful it is," and I’ll agree. Then he says "I as an artist can see how beautiful this is but you as a scientist take this all apart and it becomes a dull thing," and I think that he’s kind of nutty. First of all, the beauty that he sees is available to other people and to me too, I believe. Although I may not be quite as refined aesthetically as he is ... I can appreciate the beauty of a flower.
    [Show full text]
  • TB Notes2000
    TB Notes 2000 Think TB! Christmas Seal Campaign, 1945. Recognize possible signs and symptoms of tuberculosis. Early diagnosis and treatment reduces spread. Tent colony for TB patients, TB sanitorium, TB cases reported annually in the U.S. from Colorado Springs, Colorado. 1953, the first year of national TB surveillance. Community x-ray screening campaign. Dr. Robert Koch, discoverer of the tubercle Drugs used to treat TB disease. From left to right: bacillus, the cause of TB. isoniazid, rifampin, pyrazinamide, and ethambutol. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service __________________________________________________________________________________________________ Centers for Disease Control and Prevention (CDC) Atlanta GA 30333 TB Notes No. 1, 2000 Dear Colleague: This has been planned as a special issue to commemorate “TB Control at the Millennium.” We wanted to take the occasion to note what has been accomplished in TB control over the years, and to look forward to the challenges of the future. Our focus is mainly on progress made in this country, since that is our charge and our responsibility, but one cannot talk about TB control without talking about the important work of researchers and workers in other countries, and therefore we have included articles about international efforts as well. In this issue you will find information about the history of the interaction between mankind and Mycobacterium tuberculosis; the many accomplishments of our partners in TB contol; the past and present activities of the Division of TB Elimination (DTBE); a timeline of some of the highlights of TB control over the past century; educational materials available from DTBE; and photos of historical people, places, events, and memorabilia that we believe you will find interesting.
    [Show full text]
  • Tow Ards a Tb-Free Future
    WHO/CDS/STB/2001.13 Distribution: General Original: English STOP TB PARTNERS’ FORUM:STOP TB PARTNERS’ A TB-FREE FUTURE TOWARDS The Stop TB Partnership Secretariat is hosted by the World Health Organization 20, avenue Appia – CH-1211 Geneva 27 www.stoptb.org – [email protected] Fax (41) 22 791 4886 World Health Stop TB Organization Partnership WHO/CDS/STB/2001.13 Distribution: General Original: English 50 YEARS: HISTORICAL50 REVIEW 50 MONTHS:50 COUNTDOWN TO A TB-FREE FUTURE World Health Stop TB Organization Partnership “Our vision is one of a TB-free world: The first children born this millennium 50 YEARS: HISTORICAL50 REVIEW 50 MONTHS:50 COUNTDOWN TO A TB-FREE FUTURE will see TB eliminated in their lifetime.” iv TOWARDS A TB-FREE FUTURE © World Health Organization, 2001 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use with commercial purposes. The views expressed by named authors are solely the responsibility of those authors. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. Writing: Adrea Mach Design: Gilles Lasseigne Layout: Bruno Duret Photos: WHO & PNT Romania/Zellweger
    [Show full text]
  • Epidemiología De La Tuberculosis En La Población Infantil De Manhiça, Mozambique
    Epidemiología de la tuberculosis en la población infantil de Manhiça, Mozambique Paediatric TB epidemiology in Manhiça, southern Mozambique Elisa López Varela ADVERTIMENT. La consulta d’aquesta tesi queda condicionada a l’acceptació de les següents condicions d'ús: La difusió d’aquesta tesi per mitjà del servei TDX (www.tdx.cat) i a través del Dipòsit Digital de la UB (diposit.ub.edu) ha estat autoritzada pels titulars dels drets de propietat intel·lectual únicament per a usos privats emmarcats en activitats d’investigació i docència. No s’autoritza la seva reproducció amb finalitats de lucre ni la seva difusió i posada a disposició des d’un lloc aliè al servei TDX ni al Dipòsit Digital de la UB. No s’autoritza la presentació del seu contingut en una finestra o marc aliè a TDX o al Dipòsit Digital de la UB (framing). Aquesta reserva de drets afecta tant al resum de presentació de la tesi com als seus continguts. En la utilització o cita de parts de la tesi és obligat indicar el nom de la persona autora. ADVERTENCIA. La consulta de esta tesis queda condicionada a la aceptación de las siguientes condiciones de uso: La difusión de esta tesis por medio del servicio TDR (www.tdx.cat) y a través del Repositorio Digital de la UB (diposit.ub.edu) ha sido autorizada por los titulares de los derechos de propiedad intelectual únicamente para usos privados enmarcados en actividades de investigación y docencia. No se autoriza su reproducción con finalidades de lucro ni su difusión y puesta a disposición desde un sitio ajeno al servicio TDR o al Repositorio Digital de la UB.
    [Show full text]
  • International Journal of Tuberculosis and Lung Disease SUPPLEMENT
    Abstracts.TLD8_11.Cov1_4 10/4/04 10:27 AM Page 1 (2,1) VOLUME 8 PAGES S1–S244 VOLUME 8 NUMBER 1 NUMBER 11 ISSN 1027 3719 NOVEMBER 2004 The SUPPLEMENT 1 1 International NOVEMBER 2004 SUPPLEMENT Journal of Tuberculosis and Lung Disease 1 The Official Journal of the International Union Against Tuberculosis and Lung Disease THE INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE ABSTRACT BOOK 35th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease PARIS • FRANCE 28 OCTOBER–1 NOVEMBER 2004 PAGES S1–S244 PAGES Awards of the International Union Against Tuberculosis and Lung Disease At each Annual Union World Conference the following awards are presented: Two prizes of US $2000.00: –A Scientific Prize is awarded to a young researcher (under 45 years of age) for his/her work on tuberculosis or non-tuberculous lung disease published in the last 2 years. One copy of the publication should be sent to the Union Secretariat with the candidate’s application. –A Public Health Prize (The Karel Styblo Prize) is awarded to a health worker (physician or lay person) for his/her contribution to tuberculosis control or non-tuberculous lung disease. Applicants should include a well-documented description of his/her work, together with the comments of the manager of the association or programme. Applications, including a full curriculum vitae, should be sent by the candidates to the Union Secretariat in Paris 3 months before the World Conference (i.e., 1 July 2005). The title of Honorary Member of the Union is granted to a person who has distinguished him/herself in active participation in the Union’s activities and fulfilment of its goals.
    [Show full text]
  • Tuberculosis Disobeys Styblo's Rule
    Breaking a law: tuberculosis disobeys Styblo’s rule Christopher Dye a In 1985, Karel Styblo derived one of of progressing to disease depends on transmission rate. This seems unlikely, the guiding rules of tuberculosis (TB) various personal characteristics, such however, because drug treatment is epidemiology. Bringing together data as age, sex, genes, physiology, behav- expected to reduce the average duration from 16 countries, he proposed that an iour, and whether or not the exposure of infectivity, not to increase it. annual incidence of 50 sputum-smear- is a new infection or reinfection.3 But Adding this new evidence to the positive TB cases in a population of if this risk of 10% is roughly cor- similar results of an earlier study,4 we 100 000 generates an annual risk of rect and noting, with the postulates clearly cannot assume that Styblo’s infection of 1%.1 This rule of thumb above, that around half of all new rule still holds. How then should we quickly became an established and cases will be smear-positive, then each evaluate TB burden and trends? If cherished part of the epidemiological new smear-positive case will generate measures of the risk of infection cannot canon because it provided a way to 10 × 2 × 0.1 × 0.5 = 1 new smear-positive reliably estimate incidence, they can estimate, albeit indirectly, an important case over one transmission cycle. Un- at least measure geographical variation but elusive quantity (disease incidence) der these conditions, TB is stably en- and trends in transmission. Disease from a comparatively simple measure- demic in its host population.
    [Show full text]
  • Supplement 4: Trial by TB
    Black PMS 343 1997 Vol. 27/1 1997 Vol. P H Y S PR F I C O I A E N G S E E L D L I O N C B F E R N O U L N O S E S R A T I S S I N E G Y H O R OCEEDINGS OF COLLEGE THE OF ROYAL PHYSICIANS OF EDINBURGH 1-128 PROCEEDINGS of the ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH Vaccines from Plants Helicobacter pylori - A Review Ambulatory Paediatrics State of Consciousness The GMC and Misconduct Magic and Medicine JANUARY 1997 VOLUME 27 NUMBER 1 SUPPLEMENT NO. 4 TRIAL BY TB: a study into current attempts to control the international upsurge in tuberculosis CHRISTOPHER I HOLME JOURNALIST THE HERALD CONTENTS Preface 1 Foreword 3 Author’s note 4 Executive summary 5 List of Illustrations 6 Introduction 7 Chapter 1 The White Plague 9 Chapter 2 Post Koch, Propter Koch: The Phoney War 13 Chapter 3 Germs and Germans 18 Chapter 4 How the Chest was Won 22 Chapter 5 Third World Firsts 28 Chapter 6 How the Chest was Lost 33 Chapter 7 Captain Death Returns 36 Chapter 8 Fight Back 42 Conclusion 47 References and Notes 50 PREFACE Tuberculosis is a disease that respects no age, ethnic, geographical or socio-economic barriers or boundaries, and its incidence has gradually escalated to become the leading infectious cause of death among adults worldwide. It currently kills more women than all other causes of maternal mortality put together and ranks as the main killer of HIV-positive patients.
    [Show full text]
  • WHO Guidelines on Drug-Resistant Tuberculosis
    WHO guidelines on drug-resistant tuberculosis SCHÜNEMANN, Holger Jens ............................................................................................................ 1 LANIADO-LABORÍN, Rafael .............................................................................................................. 2 BURHAN, Erlina .................................................................................................................................... 4 CIRILLO, Daniela ................................................................................................................................. 5 DALEY, Charles ................................................................................................................................... 6 DAVIES, Geraint (Gerry) Rhys .......................................................................................................... 7 DOCKHORN COSTA JOHANSEN, Fernanda ............................................................................... 8 DOOLEY, Kelly E. ................................................................................................................................. 9 FOURIE, P. Bernardus ....................................................................................................................... 10 GEBHARD, Agnes ............................................................................................................................. 11 GURBANOVA, Elmira ......................................................................................................................
    [Show full text]
  • Short-Course Chemotherapy for Tuberculosis
    SHORT-COURSE CHEMOTHERAPY FOR TUBERCULOSIS The transcript of a Witness Seminar held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 3 February 2004 Edited by D A Christie and E M Tansey Volume 24 2005 ©The Trustee of the Wellcome Trust, London, 2005 First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2005 The Wellcome Trust Centre for the History of Medicine at University College London is funded by the Wellcome Trust, which is a registered charity, no. 210183. ISBN 0 85484 104 0 Histmed logo images courtesy of the Wellcome Library, London. Design and production: Julie Wood at Shift Key Design 020 7241 3704 All volumes freely available online following the links to publications at www.ucl.ac.uk/histmed Technology Transfer in Britain:The case of monoclonal antibodies; Self and Non-Self: A history of autoimmunity; Endogenous Opiates; The Committee on Safety of Drugs • Making the Human Body Transparent: The impact of NMR and MRI; Research in General Practice; Drugs in Psychiatric Practice; The MRC Common Cold Unit • Early Heart Transplant Surgery in the UK • Haemophilia: Recent history of clinical management • Looking at the Unborn: Historical aspects of obstetric ultrasound • Post Penicillin Antibiotics: From acceptance to resistance? • Clinical Research in Britain, 1950–1980 • Intestinal Absorption • Origins of Neonatal Intensive Care in the UK • British Contributions to Medical Research and Education in Africa after the Second World War • Childhood Asthma and Beyond • Maternal Care
    [Show full text]